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Стаття присвячена дослідженню та класифікації фігур експресивного синтаксису, що функціонують у мові поетичних творів Василя Симоненка. Встановлено роль засобів експресивного синтаксису в поетичному мовленні В. Симоненка, покласифіковано виявлені фігури за типами, розкрито причини їх використання та роль у мовотворчості поета, що забезпечує глибше зрозуміння особливостей образного мовомислення митця зокрема та літературних процесів шістдесятих років ХХ століття загалом. З’ясовано, що експресивні фігури поетичних текстів В. Симоненка репрезентують широкий спектр емоційно-психологічних реакцій і станів ліричного героя, аксіологічних вимірів фрагментів поетичної картини світу автора. Аналіз експресивних фігур уможливлює глибше розуміння світоглядної позиції автора-шістдесятника поетичних текстів, індивідуально-авторського бачення й специфічного оцінювання довкілля крізь призму додаткових, виразно емотивно-оцінних, семантичних планів лексем і фразем та їх комбінацій. Експресивність мовотворчості Василя Симоненка можна простежити фактично на всіх рівнях мовної системи, проте використання фігур експресивного синтаксису (явищ виразно самобутніх) належить до домінантних рис його ідіостилю. Фігури експресивного синтаксису увиразнюють емоційно-психологічні реакції та стани ліричного героя, посилюють аксіологічні параметри лексем і фразем у складі фігур, засобів експресивного синтаксису поезій В. Симоненка. Виявлено низку домінантних функцій фігур експресивного синтаксису в поезіях В. Симоненка: звертання акцентують увагу на особі, певному предметові чи явищі, репрезентують емоційні стани ліричного героя, увиразнюють мовлення поезій; вставні конструкції передають ставлення автора до описуваного, зображуваного; вставлені конструкції несуть додаткові повідомлення, зауваження, доповнення; еквіваленти речень найчастіше виконують спонукальну, заперечну та емоційно-оцінну функції; ампліфікація використана для посилення напруженості повідомлення, для надання контексту перелічувальної інтонації; градація посилює напруженість повідомлення; номінативні речення надають чіткості та зрозумілості мовленому, привертають увагу до певного об’єкта; еліпсис ужитий із метою досягнення напруження й стислості повідомлення; парцеляція посилює експресивність поетичних текстів, надає їм само бутніх рис; асиндетон залучає читача до участі в подіях, уможливлює наявність домислів, збагачення змісту описуваних фрагментів; замовчування посилює емоційність та напруженість мовлення.

Purpose: The aim was to determine the impact of steroid dose on effectiveness of CT-guided pudendal nerve blocks. Secondary aim was to assess predictors for response. Materials and methods: A retrospective cohort study was performed. Two-hundred-and-seventeen patients with pudendal neuralgia were identified. Of these, 189 patients had data on response and 511 pudendal nerve blocks were analyzed. Demographics, social history, initial pain data, treatment data including steroid dosing, and follow-up data were collected. Non-responders to treatment were compared to responders. Results: The majority of patients were female (92.1%) and most common areas of pain involved the vulva/labia/ perineum/vagina (scrotum) (44.2%). Treatment response rates increased with number of blocks with maximum response rate of 92.2% after fourth injection. Responders underwent more blocks within the first year (3.1 ± 1.5 vs 2.6 ± 1.6, p = 0.026). Steroid dose did not have a significant effect on response rate nor did site of injection. Non-responders were more commonly on disability due to pain ( p = 0.043). History of childhood/adolescent sexual abuse was more common in non-responders (p=0.046) and was a significant predictor of response (OR = 0.27 [0.08–0.94 95% confidence interval], p = 0.04). Conclusion: Steroid dose does not appear to have an impact on the short-term response rates to CT-guided pudendal nerve blocks in patients with clinically diagnosed pudendal neuralgia and our data may further support the discontinuation of steroids from CT block protocols. Current long-term disability leave status was a predictor of poor response along with history of childhood/adolescent sexual abuse. Adverse childhood events are easily assessed and may represent a clinical predictor of lack of response in this patient population. Clinical relevance: Approaches to managing pudendal neuralgia are varied. Steroid dose may not impact response to pudendal nerve blocks. Current disability status and history of childhood/adolescent sexual abuse may be clinical predictors of poor response to treatment.

In species with vocal learning, acquiring species-typical vocalizations relies on early social orienting. In songbirds, for example, learning song requires dynamic social interactions with a “tutor” during an early sensitive period. Here, we hypothesized that the attentional and motivational processes that support song learning recruit the oxytocin system, which is well-understood to play a role in social orienting in other species. Juvenile male zebra finches naïve to song were each tutored by two unfamiliar adult males. Before exposure to one tutor, juveniles were injected subcutaneously with oxytocin receptor antagonist (OTA; ornithine vasotocin) and before exposure to the other, saline (control). Treatment with OTA reduced behaviors associated with approach and attention during tutoring sessions. Using a novel operant paradigm to measure preference while balancing exposure to the two tutor songs, we showed that the juveniles preferred to hear the song of the control tutor. Their adult songs more closely resembled the control tutor’s song, and the magnitude of this difference was predicted by early preference for control over OTA song. Overall, oxytocin antagonism during exposure to a tutor seemed to bias juveniles against that tutor and his song. Our results suggest that oxytocin receptors are important for socially-guided vocal learning.

Quantitative fluorescence spectroscopy requires corresponding reflectance measurements to correct for tissue absorption and scattering. However, it is unclear whether fluorescence adds value beyond the diffuse reflectance measurements necessary for correction. The goal of this study was to compare the accuracy of fluorescence and diffuse reflectance spectroscopy in recovering the concentration of a high-extinction fluorophore, methylene blue (MB), using a compact fiber-optic probe. Fluorescence and diffuse reflectance measurements of tissue simulating phantoms were made using a fiber-optic probe with source-detector separations of 288-1300 μm. Average error in recovered fluorophore concentration was 20.4% for fluorescence and 15.0% for reflectance, though this difference was not significant (p=0.77). Both methods returned concentrations that were similar to known MB concentrations (p≥0.79 in both cases). Fluorescence quantification of the concentration of a high extinction fluorophore did not significantly improve accuracy relative to diffuse reflectance. Investigators should consider whether fluorescence measurements are necessary for a given application.

The majority of people in the world lack basic access to breast diagnostic imaging resulting in delay to diagnosis of breast cancer. In this study, we tested a volume sweep imaging (VSI) ultrasound protocol for evaluation of palpable breast lumps that can be performed by operators after minimal training without prior ultrasound experience as a means to increase accessibility to breast ultrasound.Medical students without prior ultrasound experience were trained for less than 2 hours on the VSI breast ultrasound protocol. Patients presenting with palpable breast lumps for standard of care ultrasound examination were scanned by a trained medical student with the VSI protocol using a Butterfly iQ handheld ultrasound probe. Video clips of the VSI scan imaging were later interpreted by an attending breast imager. Results of VSI scan interpretation were compared to the same-day standard of care ultrasound examination.Medical students scanned 170 palpable lumps with the VSI protocol. There was 97% sensitivity and 100% specificity for a breast mass on VSI corresponding to 97.6% agreement with standard of care (Cohen's κ = 0.95, P .0001). There was a detection rate of 100% for all cancer presenting as a sonographic mass. High agreement for mass characteristics between VSI and standard of care was observed, including 87% agreement on Breast Imaging-Reporting and Data System assessments (Cohen's κ = 0.82, P .0001).Breast ultrasound VSI for palpable lumps offers a promising means to increase access to diagnostic imaging in underserved areas. This approach could decrease delay to diagnosis for breast cancer, potentially improving morbidity and mortality.

BackgroundPulmonary disease is a common cause of morbidity and mortality, but the majority of the people in the world lack access to diagnostic imaging for its assessment. We conducted an implementation assessment of a potentially sustainable and cost-effective model for delivery of volume sweep imaging (VSI) lung teleultrasound in Peru. This model allows image acquisition by individuals without prior ultrasound experience after only a few hours of training.MethodsLung teleultrasound was implemented at 5 sites in rural Peru after a few hours of installation and staff training. Patients were offered free lung VSI teleultrasound examination for concerns of respiratory illness or research purposes. After ultrasound examination, patients were surveyed regarding their experience. Health staff and members of the implementation team also participated in separate interviews detailing their views of the teleultrasound system which were systematically analyzed for key themes.ResultsPatients and staff rated their experience with lung teleultrasound as overwhelmingly positive. The lung teleultrasound system was viewed as a potential way to improve access to imaging and the health of rural communities. Detailed interviews with the implementation team revealed obstacles to implementation important for consideration such as gaps in lung ultrasound understanding.ConclusionsLung VSI teleultrasound was successfully deployed to 5 health centers in rural Peru. Implementation assessment revealed enthusiasm for the system among members of the community along with important areas of consideration for future teleultrasound deployment. This system offers a potential means to increase access to imaging for pulmonary illness and improve the health of the global community.

Low back pain is the most common pain condition and cause for disability in older adults. Older adults suffering from low back pain are more disabled than their healthy peers, are more predisposed to frailty, and tend to be undertreated. The cause of increased prevalence and severity of this chronic pain condition in older adults is unknown. Here, we draw on accumulating data demonstrating a critical role for brain limbic and sensory circuitries in the emergence and experience of chronic low back pain (CLBP) and the availability of resting-state brain activity data collected at different sites to study how brain activity patterns predictive of CLBP differ between age groups. We apply a data-driven multivariate searchlight analysis to amplitude of low-frequency fluctuation brain maps to classify patients with CLBP with70% accuracy. We observe that the brain activity pattern including the paracingulate gyrus, insula/secondary somatosensory area, inferior frontal, temporal, and fusiform gyrus predicted CLBP. When separated by age groups, brain patterns predictive of older patients with CLBP showed extensive involvement of limbic brain areas including the ventromedial prefrontal cortex, the nucleus accumbens, and hippocampus, whereas only anterior insula paracingulate and fusiform gyrus predicted CLBP in the younger patients. In addition, we validated the relationships between back pain intensity ratings and CLBP brain activity patterns in an independent data set not included in our initial patterns' identification. Our results are the first to directly address how aging affects the neural signature of CLBP and point to an increased role of limbic brain areas in older patients with CLBP.

BTK inhibitors are an effective therapy for previously untreated patients with CLL but require indefinite duration treatment that can result in cumulative toxicities. Novel combinations of agents that provide deep remissions could allow for fixed duration therapy. Acalabrutinib, unlike ibrutinib, does not inhibit anti-CD20 monoclonal antibody dependent cellular phagocytosis, making it a suitable partner drug to rituximab. Using standard dosing (375mg/m2) of rituximab causes loss of target membrane CD20 immune cells and exhaustion of the finite cytotoxic capacity of the innate immune system. Alternatively, using high frequency, low dose (HFLD), subcutaneous rituximab limits loss of CD20 and allows for self-administration at home by patients. The combination of HFLD rituximab 50mg given twice a week for six cycles of 28 days with the addition of acalabrutinib starting in week 2 was evaluated in a phase II study (#NCT03788291 at clinicaltrials.gov) of 38 patients with treatment naive CLL. Patients achieving a complete response with undetectable MRD after 12 or 24 cycles of acalabrutinib could stop therapy. All patient responded, including one with a complete response with undetectable MRD in the peripheral blood and bone marrow at 12 months who stopped therapy. At a median follow-up of 2.3 years two patients with high-risk features have progressed while on acalabrutinib monotherapy. We conclude that HFLD rituximab in combination with acalabrutinib is an effective and tolerable self-administered home combination that provides a platform to build upon future regimens that may more reliably allow for fixed-duration therapy.

To identify imaging parameters that can help in the diagnosis of cardiac tamponade on non-electrocardiogram (ECG)-gated computed tomography (CT) of the chest.Retrospective analysis of 64 patients who had undergone CT and echocardiography for evaluation of cardiac tamponade. Of 64 patients, 34 were diagnosed with tamponade and underwent pericardiocentesis for further diagnosis and treatment. CT measurements obtained were: pericardial effusion (PeEff) pocket size in 6 locations (anterior, posterior, superior, inferior, right, and left lateral), pericardial thickening, diameters of the coronary sinus, upper superior vena cava, lower superior vena cava, and inferior vena cava. In addition, cardiac chamber sizes were measured. Subjective assessment of coronary sinus compression, pericardial enhancement, and pericardial thickening were also recorded.Measurement of the sum of the right lateral and left lateral PeEff thickness resulted in 91.2% sensitivity and 86.7% specificity for cardiac tamponade with a threshold of 30 mm (receiver-operating characteristic area under the curve=0.94 [0.84 to 0.98], P0.0001). Using the combination of inferior PeEff16 mm, sum of right lateral and left lateral PeEff30 mm, and presence of pericardial thickening resulted in 56% sensitivity and 100% specificity and positive predictive value for the determination of cardiac tamponade.Our study suggests that CT measurements related to PeEff size and thickness aid in the diagnosis of cardiac tamponade.

To identify CT parameters useful for assessment of pulmonary hypertension (PH) in patients with severe aortic stenosis (AS).Retrospective study of 165 patients who had undergone right heart catheterization (RHC), and CTA of the thorax for preoperative aortic valve replacement (TAVR) planning. These were divided into groups based on mean pulmonary artery (PA) pressure (mPAP) of 25 mm Hg on RHC (85 cases and 80 controls). Diameters of main pulmonary artery diameter (MPAD), left pulmonary artery (LPA), right pulmonary artery (RPA), and maximal long axis and short axis diameters of the right atrium (RA) and ventricle (RV) were measured on the axial plane. Univariate and multivariate statistical analysis was utilized to identify metrics predictive of PH.MPAD, LPA, and RPA were higher in subjects with mPAP25 mm Hg (p 0.0001 for all). Thresholds of 30.5 mm for MPAD (68.4% sensitivity, 82.7% specificity), and 27.5 mm for LPA and RPA (LPA: 51.9% sensitivity, 78.8% specificity; RPA: 62.0% sensitivity, 78.8% specificity) provided the best discrimination of elevated mPAP. Compared to literature values for MPAD (28.9 mm in men and 26.9 mm in women), these thresholds provide lower sensitivity but greatly increased specificity. Inclusion of RA enlargement to MPAD increased specificity to 98.5%, while inclusion of RV enlargement increased specificity to 100%.Threshold to identify PH in patients with AS using PA enlargement is higher than previously reported range for normal. Inclusion of RA and RV enlargement improves the ability of CT to more accurately identify PH in patients with AS.

ObjectivesPulmonary disease is a significant cause of morbidity and mortality in adults and children, but most of the world lacks diagnostic imaging for its assessment. Lung ultrasound is a portable, low-cost, and highly accurate imaging modality for assessment of pulmonary pathology including pneumonia, but its deployment is limited secondary to a lack of trained sonographers. In this study, we piloted a low-cost lung teleultrasound system in rural Peru during the COVID-19 pandemic using lung ultrasound volume sweep imaging (VSI) that can be operated by an individual without prior ultrasound training circumventing many obstacles to ultrasound deployment.DesignPilot study.SettingStudy activities took place in five health centres in rural Peru.ParticipantsThere were 213 participants presenting to rural health clinics.InterventionsIndividuals without prior ultrasound experience in rural Peru underwent brief training on how to use the teleultrasound system and perform lung ultrasound VSI. Subsequently, patients attending clinic were scanned by these previously ultrasound-naïve operators with the teleultrasound system.Primary and secondary outcome measuresRadiologists examined the ultrasound imaging to assess its diagnostic value and identify any pathology. A random subset of 20% of the scans were analysed for inter-reader reliability.ResultsLung VSI teleultrasound examinations underwent detailed analysis by two cardiothoracic attending radiologists. Of the examinations, 202 were rated of diagnostic image quality (94.8%, 95% CI 90.9% to 97.4%). There was 91% agreement between radiologists on lung ultrasound interpretation among a 20% sample of all examinations (κ=0.76, 95% CI 0.53 to 0.98). Radiologists were able to identify sequelae of COVID-19 with the predominant finding being B-lines.ConclusionLung VSI teleultrasound performed by individuals without prior training allowed diagnostic imaging of the lungs and identification of sequelae of COVID-19 infection. Deployment of lung VSI teleultrasound holds potential as a low-cost means to improve access to imaging around the world.

Recent data have shown improved outcomes in selected older adults with acute myeloid leukemia (AML) following allogeneic hematopoietic stem cell transplantation (HSCT). Nonetheless, practice patterns for referring and performing HSCT vary. We aimed to evaluate referral, utilization, and reasons for not referring/proceeding to HSCT in older adults with AML.This is a single center retrospective analysis of patients aged ≥60 years diagnosed with AML evaluating rates of HSCT referral and utilization. Fisher's exact test was used to compare rates of referral and utilization across age groups and years of diagnosis.Median age of the 97 patients was 70 years (range 61-95); 30% (29/97) were referred for HSCT and of these, 69% (20/29) received HSCT. Common documented reasons (can be multiple) for not referring were performance status (n = 21), advanced age (n = 16), patient refusal (n = 15), refractory disease (n = 14), and prohibitive comorbidity (n = 6). Among patients who were referred but did not receive HSCT (n = 9/29), documented reasons for not proceeding with HSCT were refractory disease (n = 5), advanced age (n = 2), and prohibitive comorbidity (n = 2). HSCT referral and utilization rates significantly decreased with age (p 0.01) but were generally stable over time from 2014 to 2017 (p = 0.40 for referral and p = 0.56 for utilization).Despite improvements in supportive care and HSCT techniques, HSCT referral and utilization rates remained low among older adults with AML but stable over time.

The results of saturation with alcohol solutions of hydrogel films based on copolymers of polyvinylpyrrolidone with poly-2-hydroxyethyl methacrylate have been considered in the paper. The impact of ethanol concentration which is the most often applied for the therapeutic extracts production based on medicinal herbs has been researched. The influence of samples preparation conditions on amount of alcohol- water mixture absorption was also determined.oplastic pormposites.

The method of the composite hydrogel membranes synthesis based on the 2-hydroxyethyl methacrylate (HEMA) and polyvinylpyrrolidone (PVP) with simultaneous modification in the volume by the mixture of polyamide-6 (PA-6) and PVP solution with varying the concentration of the reaction mixture in the water has been described in this study. The influence of the water content in the reaction composition on the physical mechanical properties and water absorption of the obtained membranes has been investigated.

A major challenge in the cognitive training field is inducing broad, far‐transfer training effects. Thus far, little is known about the neural mechanisms underlying broad training effects. Here, we tested a set of competitive hypotheses regarding the role of brain integration versus segregation underlying the broad training effect. We retrospectively analyzed data from a randomized controlled trial comparing neurocognitive effects of vision‐based speed of processing training (VSOP) and an active control consisting of mental leisure activities (MLA) in older adults with MCI. We classified a subset of participants in the VSOP as learners, who showed improvement in executive function and episodic memory. The other participants in the VSOP (i.e., VSOP non‐learners) and a subset of participants in the MLA (i.e., MLA non‐learners) served as controls. Structural brain networks were constructed from diffusion tensor imaging. Clustering coefficients (CCs) and characteristic path lengths were computed as measures of segregation and integration, respectively. Learners showed significantly greater global CCs after intervention than controls. Nodal CCs were selectively enhanced in cingulate cortex, parietal regions, striatum, and thalamus. Among VSOP learners, those with more severe baseline neurodegeneration had greater improvement in segregation after training. Our findings suggest broad training effects are related to enhanced segregation in selective brain networks, providing insight into cognitive training related neuroplasticity., We retrospectively analyzed data from a randomized controlled trial comparing neurocognitive effects of a vision‐based speed of processing training (VSOP) and an active control of mental leisure activities (MLA) in older adults with mild cognitive impairment. We found global segregation rather than integration was related to broad training effect. Particularly, enhanced segregation was found in selective brain networks centered in cingulate, parietal, striatal, and thalamic regions.

This study evaluated outcomes for percutaneous nephrostomy tube placement in pregnant patients, including potential complications that required early, unplanned tube exchange. A retrospective review was conducted for 51 pregnant patients and a nonpregnant cohort matched 1:1 who received percutaneous nephrostomy tube placement between 2012 and 2020. Factors potentially contributing to unplanned tube exchanges were analyzed, including gestational age, prevalence and severity of hydronephrosis, presence of renal calculi, and serum calcium level. The mean tube exchange interval was significantly shorter in the pregnant group (3.4 weeks ± 1.8 [standard deviation] vs 5.7 weeks ± 0.7, P < .0001), and pregnant subjects were significantly more likely to require reintervention before the 6-week scheduled exchange (80.4% vs 21.6%, P < .0001). The serum calcium level was lower in pregnant subjects (8.4 mg/dL ± 0.4 vs 8.9 mg/dL ± 0.7, P = .002). A shorter interval schedule (every 3 weeks) of routine percutaneous nephrostomy tube exchange in pregnant patients may be necessary to avoid complications.